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Beitragstitel The Impact of Diagnosis-Related Group Hospital Financing Reform in Switzerland
Beitragscode P028
Autor:innen
  1. Perrine Bohner Centre Hospitalier Universitaire Vaudois (CHUV) Präsentierende:r
  2. Michelle A.H. Grämiger Hopital Neuchatelois
  3. Daniel P Nguyen Hopital Neuchatelois
Präsentationsform moderierte Poster
Themengebiete
  • Blase
Abstract-Text Background: In Switzerland, a diagnosis-related group (DRG) payment system has been implemented for in-patient care in 2012. The reform aimed to increase cost transparency and improve efficiency of health care services. In this study, we evaluate the impact of the DRG reform on productivity, efficiency, and quality of care in Swiss hospitals.
Methods: Data from all Swiss hospital discharges from January 2008 to December 2016 were obtained from the Swiss Federal Statistical Office. Descriptive analyses were used for indicators at the hospital level and at the patient level. To isolate the impact of the introduction of DRG-based payment on length of stay (LOS) and readmissions within 30 days, multi-level fixed effect models were constructed, adjusting for confounders and including potential interactions. A negative binomial regression model was used for LOS and a logistic regression model for readmissions within 30 days. Additionally, autoregressive integrated moving average (ARIMA) modelling was used to estimate the effect of the introduction of DRGs on number of admissions and number of readmissions within 30 days.
Results: ARIMA modelling showed that total number of admissions did not significantly accelerate after implementation of DRGs, i.e., it continued to increase at approximately the same rate as before DRGs. Average LOS decreased continually from 2008 to 2016. Mean LOS during the pre-DRG era (2008-2011) was 7.11 ± 6.31 days compared to 6.29 ± 5.71 during the DRG era (2012-2016). In univariable and multivariable analysis, the DRG era was associated with shorter LOS. Furthermore, during the pre-DRG era, 19.8% of patients were readmitted within 30 days, while this proportion was 11.1% in the DRG era. ARIMA modelling showed that the estimated effect of the intervention was significant. Univariable and multivariable analyses confirmed that the DRG era was associated with a lower likelihood of readmissions within 30 days.
Conclusions: This study provides a thorough analysis on the impact of DRG implementation in Switzerland. The results show that while Swiss hospitals have yet to fully exploit the potential in productivity gains offered by DRG payments, there is evidence that hospitals have adapted to the payment reforms by increasing efficiency while at least maintaining quality of care as measured by readmissions.